title: Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco.
abstract: OBJECTIVE
  There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients.
  
  
  METHODS
  This is a cross-sectional study.
  
  
  METHODS
  Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort.
  
  
  METHODS
  Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression.
  
  
  RESULTS
  Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence > or =80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06-0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02-0.99) among those with < or =80% adherence and a 66% lower odds among those with >80% adherence (95% CI = 0.06-1.81).
  
  
  CONCLUSIONS
  Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.
authors.affiliation: Positive Health Program, San Francisco General Hospital, UCSF, San Francisco, CA 94143-1372, USA. Sheri.Weiser@ucsf.edu
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ragland
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005523:Food Supply / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006703:Ill-Housed Persons; D006798:Housing / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012367:RNA, Viral / Q000037:antagonists & inhibitors* / Q000096:biosynthesis* / Q000191:economics; D012495:San Francisco / Q000453:epidemiology; D019562:Viral Load / Q000191:economics
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral